Endocrine and glycaemic emergencies

Question 1

Explain fluid therapy in DKA?

Answer 1

Adults:
Shocked - 500ml over 15 mins (Repeat once again over 15min if patient remains hypotensive OR repeat dose over 45 min if blood pressure restored)

Dehydrated - 500ml over 30 mins/1000ml over 1 hour

Young adults:
If shocked 20ml/kg over 15mins

Paeds:
Shocked- 10ml/kg over 15 mins. Discuss with CHUB for repeat doses
Dehydrated - 10ml/kg over 30 mins

Question 2

What is the fluid indication for adrenal crisis?

Answer 2

Normal intravascular fluid therapy for medical emergencies, for adults:

250ml PRN boluses to maintain systolic >90mmHg

Question 3

What symptoms distinguish mild to moderate hypoglycaemia from severe hypoglycaemia?

Answer 3

Severe:
GCS≤8, convulsing, very aggitated or aggresive, comatose

Moderate:
Conscious and able to swallow but may be confused or disorientated

Mild:
Conscious, orientated and able to swallow

Question 4

What differences may be seen in the presentation of DKA vs HHS?

Answer 4

DKA:
High ketones (on monitor or ketone breath)
Kussmaul breathing
Abdominal pain
Can be only slightly raised BM

HHS:
Fatigue
Altered level of consciousness
Usually very marked BM

Both can have reduced GCS, urinary changes, fatigue, hypovolaemia etc.

Ketone levels are the only sure way to differentiate

Question 5

What are the general symptoms of hyperglycaemia?

Answer 5

SoB
Tachycardia
Hypotension
Pyrexia
Dehydration
Thirst
Polyuria
Generally unwell

Question 6

What kinds of patients are more susecpitble to adrenal crisis?

Answer 6

It should be considered in patients who have a history of:

-Known primary adrenal insufficiency
-Hypopituitarism (any known pituitary hormone deficit or clinical features indicating increased risk), or
-Previous or current prolonged course (2-4 weeks) of steroid therapy

Adrenal crisis may also be the first presentation of underlying adrenal insufficiency or there may be a history suggestive of chronic hypoadrenalism